{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:33:10Z","timestamp":1787697190797,"version":"build-2784847793"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:00:00Z","timestamp":1639612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    <jats:bold>Study Objectives:<\/jats:bold>\n                    Arousals from sleep during the hyperpneic phases of Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) in patients with heart failure are thought to cause ventilatory overshoot and a consequent longer apnea, thereby sustaining and exacerbating ventilatory instability. However, data supporting this model are lacking. We investigated the relationship between arousals, hyperpnea and post-hyperpnea apnea length during CSR-CSA.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Breath-by-breath changes in ventilation associated with the occurrence of arousal were evaluated in 18 heart failure patients with CSR-CSA, apnea-hypopnea index \u226515\/h and central apnea index \u22655\/h. The change in apnea length associated with the presence of arousal during the previous hyperpnea was also evaluated. Potential confounding variables (chemical drive, sleep stage) were controlled for.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Arousals were associated with a large increase in ventilation at the beginning of the hyperpnea (+76 \u00b1 35%,\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.0001), that rapidly declined during its crescendo phase. Around peak hyperpnea, the change in ventilation was \u22128 \u00b1 26% (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.14). The presence of arousal during the hyperpnea was associated with a median increase in the length of the subsequent apnea of +4.6% (Q1, Q2: \u22120.7%, 20.5%; range: \u22128.5%, 36.2%) (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.021). The incidence of arousals occurring at the beginning of hyperpnea and mean ventilation in the region around its peak were independent predictors of the change in apnea length (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.004 and\n                    <jats:italic>p<\/jats:italic>\n                    = 0.015, respectively; R\n                    <jats:sup>2<\/jats:sup>\n                    = 0.78).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Arousals from sleep during CSR-CSA in heart failure patients are associated with a rapidly decreasing ventilatory overshoot at the beginning of the hyperpnea, followed by a tendency toward a slight ventilatory undershoot around its peak. On average, arousals are also associated with a modest increase in post-hyperpnea apnea length; however, large increases in apnea length (&amp;gt;20%) occur in about a quarter of the patients.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2021.742458","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T14:37:45Z","timestamp":1639665465000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Interaction Between Arousals and Ventilation During Cheyne-Stokes Respiration in Heart Failure Patients: Insights From Breath-by-Breath Analysis"],"prefix":"10.3389","volume":"8","author":[{"given":"Gian 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